Understanding Patient Adherence in Chronic Respiratory Disease
Caring for asthma and COPD patients
by Eli Diacopoulos and Dr. Mark Aloia

Today, millions of people worldwide are affected by chronic respiratory conditions that make it increasingly difficult for them to breathe.

Two of the most prominent conditions are asthma and chronic obstructive pulmonary disease (COPD).

Asthma impacts an estimated 334 million people worldwide and has a significant impact on the smallest of patients—children. Around 14 percent of children worldwide experience asthma symptoms, and of these children, only one in 11 is currently receiving asthma treatment.

COPD is an irreversible illness that severely limits lung functionality. As the fourth leading cause of death worldwide, COPD accounts for more than 3 million deaths each year. In the United States, more people die annually from this disease than from breast, colorectal and prostate cancer combined.

While asthma and COPD cannot be cured, proper management can help maintain and improve a patient’s quality of life. Adherence to treatment is essential to optimize outcomes. Adherence and compliance are often used interchangeably, but there is actually a meaningful difference. The word compliance suggests that the health care professional dictates the treatment regimen and that the patient either complies with the provider’s wishes or doesn’t.

Adherence is used to emphasize the idea that the treatment regimen represents a collaboration between the patient and the provider, with the patient having a choice to adhere, or not, and how non-adherence one day can change to adherence the next.

The difference between adherence and compliance may seem subtle, but the intention is to remind both providers and patients that treatment is a collaborative process. Providers are taking a new approach to patient adherence with the help of new technology.

Shattering Misconceptions

Asthma can be particularly difficult to diagnose in young children. Learning that a child has asthma can be both a scary and stressful experience for parents—especially when navigating how to help that child manage the condition.

One of the main problems with asthma treatment is that it tends to be intermittent, managing only obvious symptoms.

Consistently, children and their parents view asthma treatment as reactive instead of proactive. Many patients take their asthma medication only when they are experiencing asthmatic symptoms rather than adhere to a daily prescription to prevent exacerbations. Asthma treatments and preventions are often steroids, which many people view negatively, as potentially damaging, especially for small children.

Even when people do adhere to their asthma medication, there is still a problem in the delivery method, as 90 percent of asthma patients use an incorrect inhaler technique, prohibiting the medication from getting directly to the patient’s lungs. Certain therapies, such as an inhaler spacer or a nebulizer, can help to improve inhaler techniques. This not only helps patients better adhere to their medication routine, but it also gives parents and caregivers more peace of mind that the patient is receiving the treatment they need in order to remain healthy. With technology becoming more patient-centric, there are now child-friendly breathing treatment devices and child-sized masks designed to make managing asthma easier for both the child and the parent.


Overcoming Adherence Challenges with COPD

Many COPD patients neglect to adhere to their specific treatment programs. As a terminal illness that attributes smoking as a key disease contributor, many patients blame themselves for their disease. This negative self-image can decrease motivation to maintain a treatment program. The underlying thought is, “It’s my fault and it’s too late anyway.” While there is no cure for the disease, there are a range of treatment options available for patients that can help to improve their quality of life.

Positive airway pressure (PAP) therapy—specifically noninvasive ventilation (NIV) therapy—is a treatment used to reduce blood CO2 levels in COPD patients. Used in the comfort of the patient’s home, NIV therapy tailors ventilation pressure to match the patient’s breathing patterns in order to maximize oxygen and has been shown to alleviate symptoms of respiratory discomfort. In addition to PAP therapy, other treatment options such as long-term therapy or portable oxygen concentrators provide patients with the freedom and flexibility to live a full and active life.

Improving Adherence with Connected Care

With a heightened focus on improving patient adherence and value-based care models, the health care industry is turning to connected care technology and AI as increasingly critical components to understanding and treating patients suffering from chronic respiratory conditions. Remote monitoring technology offers numerous benefits for both caregivers and patients by providing collaborative technology platforms, patient data and monitoring tools.

By staying connected with their providers, connected care allows a patient management or engagement service to motivate patients to stay adherent to their treatment regimen in the comfort of their own home. With these insights, patients can track their progress or set reminders to take action, as well as receive motivational messages from their physicians to encourage them to stay on track.

Connecting the Dots with Technology and Behavior Change

Connected care is just one piece of the puzzle; what is done with that connection has the potential to impact a patient’s will and desire to adhere to therapy.

The health care industry must understand that a psychological approach is needed to embrace personal health and modify unproductive habits by creating a personalized plan, providing social support how and when people need it, and empowering patients with confidence to make the right choices at the right time.

The aggregation of data can be dangerous for adherence. If patients are constantly given feedback that they are not doing well, then negative self-image worsens and motivation wanes. Connected devices are extremely powerful if the data is used effectively, with the patient’s psychological state in mind and with a keen eye for motivating someone toward behavior change. By having the resources to track personal progress and receiving motivational encouragement from their caregivers, patients with asthma and COPD are more easily and readily able to commit to therapy.

AI algorithms can be built to help identify teachable moments at any point in time and deliver the right motivators at the right time to increase patient motivation. Perhaps even more importantly, this data can tell us when to support the patient, the caregiver and the care team by identifying the patient’s strengths, not just their weaknesses.

With the adoption of connected technology, the health care industry can not only provide more effective therapy management, but also lower hospital readmission rates and improve patient outcomes for those suffering from chronic respiratory conditions. The power of connected data has never been stronger and, with the right approach, living healthily with COPD and asthma has never more achievable.